The Principle of Double Effect and Organ Donors with Hepatitis C.

Liver transplantation for hepatitis C virus (HCV) non-viremic recipients with HCV viremic donors.

Ultra-short duration direct acting antiviral prophylaxis to prevent virus transmission from hepatitis C viremic donors to hepatitis C negative kidney transplant recipients.

Short-term outcomes of deceased donor renal transplants of HCV uninfected recipients from HCV seropositive nonviremic donors and viremic donors in the era of direct-acting antivirals.

Interferon-Free Treatment Regimens for Hepatitis C: Are We There Yet?

Host-targeting agents for prevention and treatment of chronic hepatitis C – Perspectives and challenges

Hepatitis C virus resistance to protease inhibitors

Retrospective-prospective study of safety and efficacy of sofosbuvir-based direct-acting antivirals in HIV/HCV-coinfected participants with decompensated liver disease pre- or post-liver transplant.

Hepatitis C Virus Replicons Volume 3 and 4

JSH Guidelines for the Management of Hepatitis C Virus Infection: A 2016 update for genotype 1 and 2.

Introduction: Direct-acting antivirals have changed the landscape of hepatitis C virus (HCV) care. While HCV + organ transplantation is increasing, little is known about providers' attitudes towards this topic. Methods: Willing transplant and non-transplant nephrologists, transplant surgeons, and mid-level providers completed an online survey from April-May 2018. The survey asked about HCV knowledge and willingness to transplant HCV +, NAT (nucleic acid testing) + kidneys into negative recipients. Descriptive analyses including mean and median for continuous variables and frequencies for categorical variables were calculated. Results: 700 surveys were emailed and 99 providers (62 transplant nephrologists, 28 non-transplant nephrologists, 7 transplant surgeons, and 2 mid-level providers) completed the survey (participation rate 14.1%, Table 1). 100% of providers knew that HCV was curable, with 60% believing that it had no effect on transplant success and 32% thinking it reduced transplant success. Providers were significantly more likely to offer an HCV + organ to HCV + patients compared to HCV - patients in all queried circumstances (p < 0.005 in all cases, Figure 1), especially with increasing impact on patient quality of life. While only 39% of providers would offer an HCV + organ for transplant to a patient without HCV if it reduced the waitlist time by 1 year, 92% would offer an HCV + organ if it reduced the waitlist time by 4 years. However, only 47% thought the use of HCV + kidneys should be for routine care while 38% believed it should be reserved for research purposes only. There were no significant differences between transplant and non-transplant nephrologists in attitudes towards HCV + / NAT + organ transplantation. Providers believed that donor organs from those who were obese, > 50 years old, or had died from a cardiac arrest were significantly more likely to reduce the likelihood of a successful transplant 1-year post-transplant when compared with an HCV + organ (p < 0.005 in all cases, Figure 2). 86% of providers were concerned about HCV curability post-transplant as a major concern.944_A Figure 1. Demographic and practice data amongst all survey participants.944_B Figure 2. Provider attitudes towards offering HCV+/NAT+ donor organs to both HCV+ (donor+/recipient+, D+/R+, blue bars) patients and HCV- (donor+/recipient-, D+/R-, orange bars) patients. The clinical scenarios above the bars were asked of providers to determine if they would offer an HCV+/NAT+ organ. HCV: hepatitis C virus; GFR: glomerular filtration rate; QOL: quality of life; DM: diabetes mellitus; CAD: coronary artery disease; NA: not applicable.Conclusion: Although 92% of providers were willing to offer an HCV + / NAT + kidney for transplant as patient waitlist time increases, less than half of providers believed in offering HCV + transplantation for routine care rather than for research. Further provider education is needed regarding the efficacy and safety of HCV + /NAT + kidney transplantation.944_C Figure 3. Provider attitudes towards whether organ donor sources affect the likelihood of a successful transplant 1-year post-transplant. There was no difference between IVDU and HCV+/NAT+ organ, and providers believed that an organ from a patient less than 50 years old who died accidentally was significantly less likely to reduce the success of transplant compared to an HCV+/NAT+ organ. HCV: hepatitis C virus; IVDU: intravenous drug user.

Hepatitis‐Viral

With the development of effective therapies against human immunodeficiency virus (HIV), hepatitis C virus (HCV) infection has become a major cause of morbidity and mortality among patients with both infections (coinfection). In addition to the high prevalence of chronic HCV, particularly among HIV-infected injection drug users, the rate of incident HIV infections is increasing among HIV-infected men who have sex with men, leading to recommendations for education and screening for HCV in this population. Liver disease is the second leading and, in some cases, a preventable cause of death among coinfected patients. Those at risk for liver disease progression are usually treated with a combination of interferon (IFN) and ribavirin (RBV), which is not highly effective; it has low rates of sustained virologic response (SVR), especially for coinfected patients with HCV genotype 1 and those of African descent. Direct-acting antivirals might overcome factors such as immunodeficiency that can reduce the efficacy of IFN. However, for now it remains challenging to treat coinfected patients due to interactions among drugs, additive drug toxicities, and the continued need for combination therapies that include pegylated IFN. Recently developed HCV protease inhibitors such as telaprevir and boceprevir, given in combination with pegylated IFN and RBV, could increase the rate of SVR with manageable toxicity and drug interactions. We review the latest developments and obstacles to treating coinfected patients.

Author response: Efficacy of ultra-short, response-guided sofosbuvir and daclatasvir therapy for hepatitis C in a single-arm mechanistic pilot study

Editor's evaluation: Efficacy of ultra-short, response-guided sofosbuvir and daclatasvir therapy for hepatitis C in a single-arm mechanistic pilot study

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